NORS TRAINING TRAIN the TRAINER

1. NORS TRAININGTRAIN the TRAINER The National Consumer voice Annual Conference October 26, 2011

2. SESSION OVERVIEW • GOAL: Provide tips to make ongoing NORS training engaging and beneficial • FOCUS: Using the NORS Training Modules developed by state and local ombudsmen and AoA • PROCESS: • How the WINC can help • AoA’s perspective • Training tips from NORC consultant and state and local ombudsmen • Top tips from everyone • Questions and dialogue • Summary and closing

3. WINC Perspective and Process Shelley Hitt, Colorado State Ombudsman Chair, NASOP WINC Committee (303) 722-0300 x 508 1-800-288-1376 skhitt@thelegalcenter.org Workgroup to Improve NORS Consistency Process for obtaining a vetted response when questions arise

4. AoA’s Perspective Louise Ryan Ombudsman Program Specialist Administration on Aging Washington, DC 202- 357-3503

5. NORS TRAINING MODULES • PART I: Three Cs • Case, Complaint, Consultation • PART II: Complaint Codes • PART III: Verification, Disposition, Closing Cases • PART IV: Activities • FOUNDATION = NORS INSTRUCTIONS from AoA

6. NORS TRAINING in BASIC CURRICULUM • Equipping LTCO for Effective Advocacy, Curriculum • Contains opportunities for introducing NORS in bite size pieces • Integrates some of the NORS reporting with teaching the ombudsman process • Identifying the complainant and the role of the ombudsman • Verification • Intended to help new ombudsmen see NORS as part of what they do, not a stand alone, onerous process after the “good stuff” is done

7. BACKGROUND PREPARATION • Decide what to emphasize • Identify most frequent questions related to NORS reporting. • What’s the LTCOP story based on your state’s NORS data? • Review your NORS data for patterns, discrepancies, changes among local programs (regions) and for the State. • Gather applicable state policies or guidance • Responding to complaints from family members of residents • Responding to a complaint related to a resident who is deceased

8. BACKGROUND Prep continued AUDIENCE CONTENT New ombudsmen Ombudsmen, previous NORS training Mixture Basic, very clear More “what if” questions, disagreement Basics, answer questions, return to basics

9. CONTENT & LOGISTICS • What will you teach? • Which modules will you use? • Why? What do you want ombudsmen to gain from the training? • Basic NORS coding? • More clarity and consistency in using specific codes such as disposition, based on your review of the current data and your knowledge? • Do you have the most recent materials? • Check NORC website for latest versions of modules. • NORC website will contain vetted Q & As for additional clarity

10. CONTENT & LOGISTICS, continued • How much time is available? • Limit the number of module(s) to the available time • Read the modules to refresh your memory of the content and case scenarios that are included. • Which modules will take more time? Less time? • Consider the number of areas that you think need emphasis. • Anticipate questions. • Build in extra time for dialogue and for taking the quiz.

11. INTRODUCTION TO TRAINING • Why does NORS matter? • More than paper compliance • Tells story of LTCOP, national, state and local • How NORS is used on national and state levels • How local LTCOPs and individual ombudsmen can use NORS • Share a few examples illustrating the importance of consistency in coding applicable to the module you’ll cover.

12. UPFRONT CLARITY about NORS NORS DOES NORS DOES NOT Reflect local, state and national data Provide overview of range of LTCOP activities Provide information on residents’ complaints Reflect 100% of LTCO activities Reflect the quality of LTCO work Reflect LTCO time for management or other reporting purposes

13. TEACHING TIPS for MODULES Tips: Experience, Ombudsmen, Early versions of modules • State and Reiterate: Purpose is to teach coding. • When more clarity is needed • Refer to the full NORS Instructions or • Table the question and submit to WINC for a response. • Build in participation. • Shift your energy, pace, and techniques during the session. • Move around. • Jot key points on flip chart. • Ask for raised hands for some responses.

14. TEACHING TIPS FOR MODULES • Basic Principles • Ask for volunteers to read definitions aloud. • Ask group to explain differences, such as between a case and a consultation. • Ask for a few, brief examples of each principle covered. • Ask group to identify the key elements that make the example fit the specific code, in contrast to other options. • Case vs. consultation? • Verified? • Resolved vs. referred or withdrawn?

15. TEACHING TIPS for MODULES • Complaint Coding • Explain the big groupings of complaint categories, e.g. against facility, not against facility. • Ask each person to read a code and go around the room until all of the codes have been read aloud. • After each section, ask if there are any questions. • If any code is similar to a code in another category, ask participants to explain the difference. Reinforce the importance of thinking about the context and primary complaint. • Example: Several codes and at least three categories relate to communication.

16. TEACHING TIPS for MODULES • B is Access to Information by resident. B14: Information communicated in understandable language. • D is autonomy, Choice, Preference, Exercise of Rights, Privacy. D29 is used if caregiver does not speak the resident’s language or if resident cannot communicate. • M is staffing. M96 is used for staff language or other communication barrier related to staff. • A resident has not received any information about the facility’s services…in German, though it is the resident’s primary language. (B14) • If time is too short to cover all codes, select a few key codes to read and discuss in each big category. • Ask for brief examples of a case that relates to a particular category or code, as each category is covered.

17. QUIZ • Purpose • Learning • Affirmation of knowledge • Assist with accurate reflection of LTCOP’s story • Self-Grading • Use answer key and your background prep to identify areas to focus on for • Questions, • Dialogue, or • Clarity about program policies.

18. QUIZ • Check for understanding of the principles. • Select a few questions where there may be uncertainty. • Ask why the answer is correct. • What would have to change to use a different code? • Select codes where you receive questions, give another example and ask the group what code to use. • If there are different views about the correct answer, ask ombudsmen to explain the rationale for their answers. • Discuss responses. • Explain why the answer is the answer. • Why is the answer X instead of Y?

19. QUIZ • Bonus Questions may be used for ombudsmen who are waiting for everyone else to finish the quiz. • Add some fun. • Give prizes for correct responses. • Sign pages/quizzes with 100% correct responses. Use the pages to draw for prizes. • Divide into teams and give prizes to team with most correct responses. • Toss candy, gum, etc., to individuals who share an example or ask a question.

20. STATING THE OBVIOUS, TIPS • Don’t over-think the scenarios. • NORS coding is about making a choice. • Typically, the NORS code is the big thing that jumps out, the best fit. • Return to the NORS Instructions for further assistance and encourage ombudsmen to do this. • Keep the module focus on the context and purpose. • If it’s Module III, the context for choosing a code is the verification, disposition and closing. • Do not second guess the issues or the ombudsman investigation.

21. STATING THE OBVIOUS, TIPS • Use the NORS Modules to teach coding. • Avoid becoming sidetracked by lengthy discussions of ombudsman skills and approaches. • Take advantage of teachable moments. Include some applicable program policy and good ombudsman practice pointers in the discussion as time permits. • Too many what if scenarios may increase confusion and divert the focus. • After discussion, return to the correct answer with a brief rationale explaining why the answer is correct. • If a quiz answer may be confusing for new ombudsmen, e.g. the answer rationale includes it depends, discuss that question last.

22. STATING THE OBVIOUS, TIPS Ongoing training is essential for everyone. Experience and repetition increase understanding, reinforce learning and retention. Need NORS training opportunities to avoid any tendencies to develop individual variations in NORS coding. Share your innovations in teaching with us!

23. TIPS from VERMONT Jackie Majoros, State Long-Term Care Ombudsman Vermont Legal Aid Burlington, Vermont 802-863-7155 x227

24. TIPS from CALIFORNIA Joe Rodrigues, State Long-Term Care Ombudsman California Department of AgingSacramento, California916-419-7510

25. TIPS from Maryland Eileen Bennett, Program Manager Long-Term Care Ombudsman Program Montgomery County Department of Health & Human Services Rockville, Maryland 240-777-1067

26. TIPS from PENNSYLVANIA Kimberly Shetler, Regional Ombudsman Coordinator Office of the State Long-Term Care Ombudsman Bloomsburg, Pennsylvania 570-784-4420s

27. TIPS from COLORADO Shelley Hitt, Colorado State Long-Term Care Ombudsman The Legal Center Denver, Colorado 303-722-0300 x 508 1-800-288-1376

28. YOUR TIPS & QUESTIONS

29. The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) http://www.theconsumervoice.org/ This presentation was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services.